Provider Demographics
NPI:1962633925
Name:PATE, ERICKA KELLER (NP)
Entity Type:Individual
Prefix:MRS
First Name:ERICKA
Middle Name:KELLER
Last Name:PATE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P O BOX 50
Mailing Address - Street 2:355 HIGHWAY 3142
Mailing Address - City:HAHNVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70057
Mailing Address - Country:US
Mailing Address - Phone:985-783-5668
Mailing Address - Fax:985-783-4179
Practice Address - Street 1:355 HIGHWAY 3142
Practice Address - Street 2:
Practice Address - City:HAHNVILLE
Practice Address - State:LA
Practice Address - Zip Code:70057
Practice Address - Country:US
Practice Address - Phone:985-783-5668
Practice Address - Fax:985-783-4179
Is Sole Proprietor?:No
Enumeration Date:2009-08-07
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP05887363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health